1.

What are the risk factors contributing to

pressure area breakdown/ulcers?
Poor mobility/immobility: Patients who are unable to independently change position
are at increased risk of developing a pressure ulcer, due to pressure exerted over bony
prominences which results in reduced blood flow to the tissues and subsequent hypoxia.

Poor nutritional status: Although there are few studies to support this idea, it is widely
accepted (based on anecdotal evidence) that patients who are compromised nutritionally
are at higher risk for the development of pressure ulcers; for this reason, patients
with poor nutritional status may benefit from a dietary consult.

Compromised blood flow: Whenever there is compromised blood flow to the tissues,
there is increased risk of pressure ulcer development. What are some common reasons
that blood flow might be compromised? Peripheral arterial disease (PAD), venous
insufficiency and shock are common culprits.

Neuropathy/compromised sensation: Obviously, if you cannot feel pain or pressure,

you are at higher risk of developing a pressure ulcer. Patients who fit into this category
include patients with spinal cord damage, stroke, MS, neuropathy and other conditions
that compromise ones ability to perceive pain and/or pressure.

Skin color/changes: Patients with darker skin pigmentation may be at risk for pressure
ulcers simply because health care professionals fail to recognize the early signs of
pressure damage (i.e. blanching erythema). In addition, patients with conditions that
change the normal appearance of the skin are at high risk (e.g. patients with bruising,
dermatitis, eczema and other skin diseases).

Support surfaces: The surface upon with the patient lies or sits can profoundly
influence pressure over bony prominences, as can lying or sitting in the same position
for long periods of time. Support surfaces should be assessed frequently and adjusted
accordingly.

Pain: Pain may prevent patients from moving, even when they are feeling the
unpleasant effects of pressure. Too much pain medication may sedate patients to the
point where they dont change position as often as they should. Patients should be
assessed for their ability to move while still maintaining an acceptable level of comfort.

Age: At the extremes of age, patients may be at higher risk for the development of
pressure ulcers due to inability to move/change position independently. Very young
infants are unable to change position by themselves; the elderly may be similarly unable
to change position due to other health problems limiting movement.
 Mental status: Patients suffering from dementia or other cognitive disorders may be
unable to comprehend instruction given that could help prevent pressure injuries, or may
fail to recognize discomfort as a signal to change position.

Incontinence: Incontinence may cause skin damage that can increase the risk of
developing pressure ulcers. This skin damage may make it more difficult for health care
professionals to recognize the early warning signs of pressure ulcers (i.e. reddened
areas of skin that blanch when light pressure is applied).

2. What people are at risk of having pressure area

breakdown/ulcers?
Anyone can get a pressure ulcer, but the following things can make them more likely to
form:
being over 70 older people are more likely to have mobility problems and have skin
that's more easily damaged through dehydration and other factors
being confined to bed with illness or after surgery
inability to move some or all of the body (paralysis)
obesity
urinary incontinence and bowel incontinence
a poor diet
medical conditions that affect blood supply, make skin more fragile or cause movement
problems such as diabetes, peripheral arterial disease, kidney failure, heart
failure, multiple sclerosis (MS)and Parkinson's disease

3.What strategies can you use to prevent

pressure area breakdown/ulcer?

1. Risk Assessment: risk assessment tools, such as the Braden scale, help caretakers
recognize a patients risk of developing pressure ulcers. Clearly documented risk assessment is
vital in preventing and treating pressure ulcers.
2. Skin Inspections: a patients skin should be examined regularly for signs of pressure
damage. The first sign of tissue damage is often non-blanching erythema. Other signs of skin
damage include heat, induration and swelling.
3. Skin care: keeping a patients skin clean, dry, and hydrated can help prevent damage. Skin
should be dried carefully and any rubbing or friction should be avoided.
4. Moisture: excessive perspiration, oedema and incontinence can cause skin damage from
excess moisture. Incontinence can be particularly harmful to a patients skin and appropriate
measures should be taken to prevent any associated damage.
5. Incontinence: incontinence and pressure ulcers often co-exist. The use of incontinence pads
with the appropriate application of a barrier cream can be helpful, while the use of indwelling
urethral catheters should only be considered as a last resort due to the risk of infection.
6. Nutrition: good nutrition is essential for pressure ulcer prevention and healing. A Patients
diet should be assessed regularly and any nutritional needs should be addressed. Keeping
patients hydrated is also a vital part of preventing pressure ulcers.
7. Position: the position of a patients body should be considered when trying to prevent
pressure ulcers.
8. Ergonomics: ergonomics refers to making sure a patients environment is suited to aiding in
the performance of everyday tasks. It is important to consider ergonomics when choosing the
size and placement of furniture such as beds, chairs and mattresses.
9. Repositioning: all patients should be encouraged to reposition themselves regularly. For
patients who require assistance, repositioning should be done with consideration for the
patients comfort, dignity and functional ability.
10. Pressure-redistributing equipment: pressure ulcer equipment has two main functions
to redistribute pressure and to provide comfort. Mattresses and seating must provide pressure-
reducing cushioning for patients at high risk for developing pressure ulcers.

4.Where would you find information in care

plan relating to residents individual pressure
area care need?
On the body map,daily records.

5.How do you identify the risk of skin

breakdown?
1. Determine client's risk for skin breakdown using a risk assessment tool (e.g. Knoll
Assessment Tool, Braden Scale, Gosnell Scale).
2. Inspect the skin, especially bony prominences and dependent areas, for pallor, redness,
and breakdown.
3. Implement measures to prevent tissue breakdown:
A. assist client to turn at least every 2 hours unless contraindicated
B. position client properly; use pressure-reducing or pressure-relieving devices (e.g.
pillows, gel or foam cushions, alternating pressure mattress, air-fluidized bed,
kinetic bed) if indicated
C. gently massage around reddened areas at least every 2 hours
D. apply a thin layer of a dry lubricant such as powder or cornstarch to bottom sheet
or skin and to opposing skin surfaces (e.g. axillae, beneath breasts) if
indicated to reduce friction
E. lift and move client carefully using a turn sheet and adequate assistance
 F. perform actions to keep client from sliding down in bed (e.g. gatch knees slightly
when head of bed is elevated 30 or higher) in order to reduce the risk of skin
surface abrasion and shearing
G. instruct or assist client to shift weight at least every 30 minutes
H. keep client's skin clean
I. thoroughly dry skin after bathing and as often as needed, paying special attention
to skin folds and opposing skin surfaces (e.g. axillae, perineum, beneath
breasts); pat skin dry rather than rub
J. keep bed linens dry and wrinkle-free
K. ensure that external devices such as braces, casts, and restraints are applied
properly
L. protect the skin from contact with urine and feces (e.g. keep perineal area clean
and dry, apply a protective ointment or cream to perineal area)
M. perform actions to prevent drying of the skin:
I. encourage a fluid intake of 2500 ml/day unless contraindicated
II. provide a mild soap for bathing
III. apply moisturizing lotion and/or emollient to skin at least once a day
N. apply a protective covering such as a hydrocolloid or transparent membrane
dressing to areas of the skin susceptible to breakdown (e.g. coccyx, heels,
elbows)
O. perform actions to maintain an adequate nutritional status (see Diagnosis 3,
action c)
P. if edema is present:
I. perform actions to reduce fluid accumulation in dependent areas:
a. instruct client in and assist with range of motion exercises
b. elevate affected extremities whenever possible
II. handle edematous areas carefully
Q. increase activity as allowed.
4. If tissue breakdown occurs:
A. notify appropriate health care provider (e.g. physician, wound care specialist)
B. perform care of involved areas as ordered or per standard hospital procedure.

6.How you would relieve pressure from the

pressure area?

Changing position
Moving and regularly changing your position helps to relieve the pressure on ulcers that have
already developed. It also helps prevent pressure ulcers developing.
After your care team has carried out an assessment of your risk of developing pressure ulcers,
they will draw up a repositioning timetable. This states how often you need to move, or be
moved if you're unable to do so yourself.
For some people, this may be as often as once every 15 minutes. Others may need to be
moved only once every two to four hours.
You may also be given training and advice about:
 correct sitting and lying positions
how you can adjust your sitting and lying positions
how best to support your feet to relieve pressure on your heels
any special equipment you need and how to use it

Mattresses and cushions

If you're at risk of getting pressure ulcers or have a minor ulcer, your care team will recommend
a specially designed static foam or dynamic mattress.
If you have a more serious ulcer, you will require a more sophisticated mattress or bed system,
such as a mattress connected to a pump that delivers a constant flow of air into the mattress
itself.
There are also a range of foam or pressure-redistributing cushions available. Ask your carer
about the types most suitable for you.
But according to the National Institute for Health and Care Excellence (NICE), there's limited
evidence on what kinds of pressure-redistributing devices are best for the relief and prevention
of pressure ulcers in different places, such as heels or hips.

Dressings
Specially designed dressings can be used to protect pressure ulcers and speed up the healing
process.

Creams and ointments

Topical antiseptic or antimicrobial (antibiotic) creams and ointments aren't usually
recommended for treating pressure ulcers.
But barrier creams may be needed to protect skin that's been damaged or irritated by
incontinence.

Antibiotics
Antibiotics may be prescribed to treat an infected ulcer or if you have a serious infection, such
as:
blood poisoning (sepsis)
bacterial infection of tissues under the skin (cellulitis)
infection of the bone (osteomyelitis)

Diet and nutrition

Eating a healthy, balanced diet that contains enough protein and a good variety of vitamins and
minerals can speed up the healing process.
If your diet is poor, you may see a dietitian. They can draw up a suitable dietary plan for you.
It's also important to keep up fluid intake to avoid dehydration, as being dehydrated can slow
down the healing process.
Removing damaged tissue (debridement)
In some cases, it may be necessary to remove dead tissue from the pressure ulcer to help it
heal. This is known as debridement.
If there's a small amount of dead tissue, it may be removed using specially designed dressings.
Larger amounts of dead tissue may be removed using:
high-pressure water jets
ultrasound
surgical instruments, such as scalpels and forceps
A local anaesthetic should be used to numb the area around the ulcer so debridement (if not
being treated with a dressing) doesn't cause you any pain.

Surgery
Severe pressure ulcers might not heal on their own. In such cases, surgery may be required to
seal the wound, speed up healing, and minimise the risk of infection.
Surgical treatment involves:
cleaning the wound and closing it by bringing the edges of the ulcer together
cleaning the wound and using tissue from healthy skin nearby to close the ulcer
Pressure ulcer surgery can be challenging, especially because most people who have the
procedure are already in a poor state of health.

7.Who would you report a skin breakdown and

why?

You need to report to nurse or a senior carer.

Observing and reporting skin problems to the nurse,can prevent further skin breakdown.